Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma-Case report
| العنوان: | Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma-Case report |
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| المؤلفون: | R. Escrevente, Luciana Pereira, P. Jácome, G. Gomes, J. Pimenta de Castro, N. Mateus |
| المصدر: | International Journal of Surgery Case Reports |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | medicine.medical_specialty, business.industry, Perforation (oil well), Blunt abdominal trauma, Case Report, medicine.disease, Mesenteric injury, Surgery, Small bowell perforation, Blunt, medicine.anatomical_structure, Abdominal trauma, medicine, Mesentery, business |
| الوصف: | Highlights • Blunt abdominal trauma after injury with a straw of bale in a rural hospital. • Prompt evaluation with FAST and computed tomography did not show small bowell perforation. • Despite this the patient went to surgery wich revealed jejunal perforation. • Missed or another perforation needing re-surgery. • Highly clinical suspicion depending on the mechanism of abdominal trauma. Introduction In blunt abdominal trauma, lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality. Presentation of case The authors present the case of a 68 years old male, admitted to the emergency department after being hit by a bale of straw, weighing around 300 kg, in the abdomen. After successful ressuscitation, a CT scan was performed, suggesting hemoperitoneum because of vascular lesion of the right colon bleeding. An exploratory laparotomy was performed, confirming the presence of blood in the abdominal cavity and identifying jejunal perforation, an apparently innocent hematoma of the small bowel mesentery (beside the bowel wall) distally to the first lesion and a laceration of the sigmoid serosa; a segmental jejunal resection and suture of the colon serosa were performed. In the early post-operative period, an enteric discharge was noticed, mandating surgical reexploration; a previously unnoticed bowel perforation, in the mesenteric border where the hematoma was identified, justified an additional enterectomy, after what the patients recovery progressed uneventfully. Discussion In this case, a sudden increase in abdominal pressure could explain that missed rupture of the mesenteric border of the jejunum, also causing the mesenteric hematoma, or, in spite of that, a state of low perfusion could have lead to total wall ischemia of an already irrigation compromised segment. Only noted after surgical exploration, despite prior evaluation with a computed tomography. Small bowell and mesenteric injuries are potentially missed due to decreased exploratory laparotomies for blunt abdominal trauma. Conclusion Although uncommon, small bowel and mesenteric injuries are associated with high morbidity and mortality. High clinical suspicion is essential for an early diagnosis |
| تدمد: | 2210-2612 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1a9d0ec1dfc9817510a206147ead587d https://pubmed.ncbi.nlm.nih.gov/25576959 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1a9d0ec1dfc9817510a206147ead587d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 22102612 |
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